Sarajena, Diana .

HRN: 27-11-32  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/29/2025
AMPICILLIN 1GM (VIAL)
05/29/2025
05/30/2025
IVT
2g
Q6 ANST
Prom
Checking Initial Appropriateness 
05/31/2025
CEFUROXIME 500MG (TAB)
05/31/2025
06/07/2025
ORAL
500 Mg
BID
S/P NSD With Repair; PROM
Checking Initial Appropriateness 
05/31/2025
METRONIDAZOLE 500MG (TAB)
05/31/2025
06/07/2025
ORAL
500mg
TID
S/P NSD With Repair; PROM
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: